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The recommendations made in the guidelines were generally in agreement about the indication for and approach to drug selection for prophylactic treatment but some difference, were evident in recommendations for specific agents. Most disagreements occurred for drugs for which evidence is insufficient because of obsolescence of studies, few studies, or inconclusive studies. Few differences were owing to regional differences in drug licensure. For acute treatment, there was more diversity in the approach to drug selection (stepped versus stratified management) but similar diversity in specific...

The recommendations made in the guidelines were generally in agreement about the indication for and approach to drug selection for prophylactic treatment but some difference, were evident in recommendations for specific agents. Most disagreements occurred for drugs for which evidence is insufficient because of obsolescence of studies, few studies, or inconclusive studies. Few differences were owing to regional differences in drug licensure. For acute treatment, there was more diversity in the approach to drug selection (stepped versus stratified management) but similar diversity in specific drugs recommended; however, relatively more diversity was due to regional availability of specific drugs.

Many single-country guidelines published early in the observation period were not updated.

Although there is a high degree or international consensus on recommendations for clinical care in drug treatment of migraine, there are still many differences among specific guidelines, related not only to differences in drug availability or licensing but more often to insufficient evidence. Furthermore, infrequent updating of guidelines leads to obsolescence. The influence of professional bodies may be an important factor in explaining international consensus and are the most likely avenue for international harmonization of headache guidelines.